A Guide to NP Independent Practice

A nurse standing with her hand on her hip.

Licensure and regulatory requirements for nurse practitioners (NPs) vary by state. The topic of NP independent practice has become a central issue for the profession and the healthcare industry, as NPs can help with the shortage of primary care providers. Expanding NP independent practice also improves access to healthcare, boosts the quality of healthcare and lowers patient costs, according to the Pennsylvania Coalition of Nurse Practitioners (PCNP).

In some states, NPs can practice independently and run full-service clinics. Other states reduce or restrict certain elements of practice for these professionals. In February 2017, South Dakota became the 22nd state (plus the District of Columbia) to enact full practice authority for NPs.

The following sections discuss NP independent practice, scope of practice and Pennsylvania’s classification of reduced practice.

What Is an NP?

An NP or certified registered nurse practitioner (CRNP) has advanced education and clinical training in a healthcare specialty area, according to the PCNP. NPs work with families and people of all ages, providing the information that people need to make informed decisions about their healthcare and lifestyle choices.

NPs may be found in all 50 states and practice under the rules and regulations of the Nurse Practice Act of the state where they work. Most NPs are nationally certified in their specialty area, and they are recognized as expert healthcare providers.

NPs are able to serve as the regular healthcare provider for children and adults during health and illness. They work in rural and urban settings such as physician offices, hospitals, health clinics and offices, nursing homes and hospices, and more to:

  • Obtain medical histories and perform physical examinations
  • Diagnose and treat acute health problems and chronic diseases
  • Order, perform and interpret diagnostic studies
  • Prescribe medication and other treatments
  • Provide prenatal care, well-child care and health maintenance care
  • Promote positive health behaviors and self-care skills through education and counseling
  • Collaborate with physicians and other health professionals as needed

In addition to patient care, NPs are actively involved in education, research and legislative activities to promote quality healthcare.

Independent Practice and Scope of Practice

Independent practice refers to an NP’s ability to provide care without mandated supervision from a physician. Each state’s degree of independence for NPs is categorized in the following ways.

Full Practice

All NPs can evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments — including prescribe medications — under the exclusive licensure authority of the state board of nursing.

Reduced Practice

NPs have reduced ability in at least one element of NP practice. State law requires a regulated collaborative agreement with an outside health discipline for the NP to provide patient care, or it limits the setting or scope of one or more elements of NP practice.

Restricted Practice

NPs are restricted in at least one element of NP practice. State law requires supervision, delegation or team management by an outside health discipline for the NP to provide patient care.

A map depicting state-by-state scope of practice for nurse practitioners.

How Does Pennsylvania Compare?

Pennsylvania is one of 16 states that have reduced practice for NPs. Twelve states have restricted practice, and 22 states plus the District of Columbia have full practice. These numbers are accurate as of April 2017.

NPs in Pennsylvania must secure business contracts with two physicians in order to practice, according to the PCNP. Advocates are gaining support for full practice in the state, and there are bills in the state House and Senate that would update the Pennsylvania Nurse Practitioner Act to grant NPs who are certified full practice authority.

The Importance of Achieving NP Independent Practice

Full practice or NP independent practice is the model recommended by the Institute of Medicine, the National Council of State Boards of Nursing and other health and policy makers.

More than 100 major studies over the past 40 years on NP care show that NPs’ patient health outcomes are as good or better than other providers, according to the PCNP. And given the shortage of primary care providers, patients need better access to primary care. This is especially true in underserved rural and urban areas. NPs are twice as likely as physicians to serve rural communities, and NPs in states with full practice authority are more likely to practice in rural areas compared to states (like Pennsylvania) without it.

It also saves money. “Unlike other proposals to expand access to care, full practice authority won’t cost taxpayers a dime,” the PCNP said.

Advancing Nurse Care

NPs and other advanced practice registered nurses (APRNs) can further their education to enhance the quality of patient care and pursue more advanced career opportunities. Alvernia University’s online DNP is designed for APRNs seeking a practice doctorate in clinical leadership to advance their careers to the highest levels in nursing. The program takes place in a convenient online learning environment that accommodates students’ work and personal schedules.